Provider Demographics
NPI:1780642066
Name:GRIN, TRUDI R (MD)
Entity Type:Individual
Prefix:DR
First Name:TRUDI
Middle Name:R
Last Name:GRIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:TRUDI
Other - Middle Name:
Other - Last Name:GRIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:4820 COLLEGE BLVD
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1601
Mailing Address - Country:US
Mailing Address - Phone:913-888-1888
Mailing Address - Fax:913-888-1975
Practice Address - Street 1:4820 COLLEGE BLVD
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1601
Practice Address - Country:US
Practice Address - Phone:913-888-1888
Practice Address - Fax:913-888-1975
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-21306207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D16864Medicare UPIN